应用头影测量结合Müller试验评价肥胖对阻塞性睡眠呼吸暂停低通气综合征患者上气道可塌陷性的影响

The utility of cephalometry with Müller's maneuver to evaluate obesity on upper airway collapsibility in obstructive sleep apnea and hypopnea syndrome patients

目的应用X线头影测量结合Müller试验分析不同肥胖程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的颅颌面结构、上气道软组织解剖结构的差异,并评价肥胖对OSAHS患者上气道可塌陷性的影响。方法收集男性患者39例,记录其基本生理信息,多导睡眠监测结果,平静呼气末及Müller相侧位片。以体重指数(BMI)24 kg?m-2为界对纳入人群进行分类,分为正常体重组12人,肥胖+超重组27人。应用Cassos 2001计算机辅助测量软件对Müller试验实施前后患者颅颌面软硬组织和上气道及周围组织结构进行数据测量,并进行统计分析。结果肥胖+超重组OSAHS患者与正常体重组相比,其颅颌面硬组织差异不明显,而在上气道及周围组织特征上,肥胖+超重组表现为上气道各平面矢状径均增大,其中在腭后区、腭尖平面及舌后区差异显著。除此之外,在肥胖+超重组中,实施Müller试验后患者上气道各层面塌陷显著,但正常体重组不明显。结论肥胖OSAHS患者与正常体重患者的致病因素可能存在差别,上气道管腔对负压的敏感性增加可能是促成肥胖伴OSAHS的病因之一。

Objective To evaluate the changes in upper airway and surrounding structures under intraluminal pressure using cephalometry with Müller＇s maneuver in obese and overweight obstructive sleep apnea and hypopnea syndrome（OSAHS） patients and non-obese controls. Methods Thirty-nine male patients were enrolled, anthropometric measurements and polysomnography data were collected prior to the study. Lateral cephalograms of each patient were obtained either at the end-expiration phase or the Müller＇s maneuver phase. The patients included in the study were classified into two groups according to the body mass index（BMI）. The BMI of patients〈 24 kg·m-2 was regarded as normal group, including 12 cases; while the obese group includes 27 cases. Craniofacial and upper airway structures were measured in lateral cephalometry using Cassos 2001 computed aided measurement software before and after the patients＇ practicing the Müller＇s maneuver. Results Two groups are similar in the craniofacial hard bony structures. However, when compared with the upper airway and surrounding structures, the obesity group exhibits a wider anterior-posterior dimension of upper airway, especially significant in retropalatal, tip of the palatal, retroglossal area. In addition, the obesity group shows a more collapsible airway than the controls after practicing the Müller＇s maneuver. Conclusion The pathogenesis of OSAHS in obese patient may different from the patients of normal weight. The increased compliance to negative intraluminal pressure may predispose to the onset of OSAHS with obese status.